Benign Paroxysmal Positional Vertigo (BPPV) |
Short lived (20-30 secs) vertigo brought on by lying down, turning over or
getting out of bed. Resolves when still. No spontaneous nystagmus |
- Dix-Hallpike Maneuver: Positional test to diagnose BPPV.
- Head Impulse Test: To evaluate vestibular function.
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- Epley Maneuver: Repositioning technique to move dislodged crystals in the inner ear.
- Brandt-Daroff Exercises: Home exercises to manage symptoms.
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Meniere's Disease |
Older patient. Chronic hearing loss, tinnitus and episodes of vertigo. Not positional |
- Audiometry: Hearing test to assess for hearing loss.
- Electrocochleography: To detect abnormal inner ear fluid levels.
- Vestibular Testing: Includes caloric testing and VEMP (Vestibular Evoked Myogenic Potentials).
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- Dietary Modifications: Low-sodium diet to reduce fluid retention.
- Medications: Diuretics, betahistine, and anti-vertigo medications.
- Intratympanic Injections: Corticosteroids or gentamicin for severe cases.
- Surgery: Endolymphatic sac decompression or vestibular nerve section in refractory cases.
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Vestibular Neuritis |
Hours or days of constant severe vertigo, worse with head movements.
Difficult with gait. Spontaneous or gaze evoked nystagmus in first few
days. Resolves over a few weeks |
- Clinical Diagnosis: Based on the sudden onset of vertigo without hearing loss.
- Head Impulse Test: To confirm a peripheral vestibular disorder.
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- Corticosteroids: To reduce inflammation.
- Vestibular Rehabilitation: Exercises to promote central compensation.
- Symptomatic Treatment: Antiemetics and vestibular suppressants for acute relief.
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Vestibular migraine |
Often under-diagnosed. Multiple episodes of dizziness lasting minutes to
days. History of migraines. Half of the episodes have either typical
migraine headache, and/or associated photophobia/phonophobia |
- Clinical Diagnosis: Based on atypical features and migrainous features.
- MRI To exclude stroke in some.
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- Corticosteroids: To reduce inflammation.
- Vestibular Rehabilitation: Exercises to promote central compensation.
- Symptomatic Treatment: Antiemetics and vestibular suppressants for acute relief.
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Labyrinthitis | |
- Audiometry: To assess for hearing loss associated with labyrinthitis.
- MRI or CT Scan: To rule out other central causes of vertigo.
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- Antibiotics: If bacterial infection is suspected.
- Antiviral Medications: For viral causes.
- Corticosteroids: To reduce inflammation.
- Vestibular Rehabilitation: Exercises to aid in recovery.
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Central Causes (e.g., Stroke, Multiple Sclerosis) |
Posterior circulation stroke - Can present similar to vestibular neuritis. May have focal paresthesia,
weakness, headache or neck pain, and Deadly Ds: dysarthria, diplopia,
dysmetria, dysphonia, dysphagia |
- MRI or CT Scan: To detect brain lesions or abnormalities.
- Neurological Examination: To assess for central nervous system involvement.
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- Neurological Treatment: Based on the underlying condition (e.g., stroke management protocols).
- Physical Therapy: To help with balance and coordination.
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